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Front end duties


when collecting basic info, who do you go to? go to the patient and family
when you get the basic info what do you compare it to? to what is in the medical record or financial record
what do you if the info doesn't match? flags can show up to indicate a possible problem. Then further verification can be requested,
whats the 1st step to verify the pt's health ins? the staff member asks to see the pt's health ins card to compare it to the info on file
Why does the staff member call the ins comp? to double-check that the ins info is valid, before starting the conversation it is essential to write down the name of the person who is providing this info
birthday rule applies to dependent kids whose parents have more than 1 ins policy. the parent whose bday comes 1st in the calendar yr. is designated as the primary plan
third-party liability ins if an accident has occurred the 3rd party liability ins should be filed as primary
medicare vs medicaid for pts enrolled in both medicare & Medicaid, medicare always pays for services 1st. Medicaid is referred as the payer of last resort
state children health ins program this program is jointly funded by the fed/gov & the states
what are the 2 kinds of commercial ins? private & employer- based self ins
private health ins plans these plans are paid for through premiums, which are a pre-established amt set by ins comp & paid regularly
employers-based self ins comps save $ by self insuring their employee health plans rather than buying coverage from private ins comps, costs are lower
blue cross & blue shield plans these plans were the 1st prepaid plans in the U.S. Originally blue cross covered hospital care & blue shield covered physician services, They merged to form blue cross & blue shield association (BC/BS) in 1982
what are 2 major categories? HMOs & PPOs
Created by: diasiar